NPIMap

Individual provider Active NPI

Joel Wietfeldt, MD

  • Plastic and Reconstructive Surgery Physician
  • Springfield, IL
National Provider Identifier
1497977888
Registry record updated May 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
036129983 Issued in IL
Practice address
2901 Greenbriar Dr
Springfield, IL 62704-6425
Phone
(217) 528-7541
NPI assigned
May 3, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery Physician 2086S0122X 036129983 IL Primary

Addresses

Primary practice location

2901 Greenbriar Dr
Springfield, IL 62704-6425

Mailing address

1025 S 6TH St
Springfield, IL 62703-2403
Phone (217) 528-7541

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address joelwietfeldt@sfc.allscriptsdirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120817000161 IL Practitioner - Plastic and Reconstructive Surgery 6305092735 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Southern Illinois University School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Springfield Clinic, LLPGroup PAC ID 0547166076, 678 clinicians

Practice addresses (Care Compare)

2901 Greenbriar Dr
Springfield, IL 62704-6425
Phone (217) 528-7541

Hospital & facility affiliations

  • Memorial Medical Center Hospital, Springfield, IL, CCN 140148
  • Hillsboro Area Hospital Hospital, Hillsboro, IL, CCN 141332

Merit-based Incentive Payment System (MIPS)

Final score
88.83 of 100Reported as apm
Quality
75.65
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy11
Melanoma (skin cancer) excision64
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Springfield Clinic LLP CurrentSince Dec 1, 2012 Accepting new patients
Springfield Clinic, LLP CurrentSince Sep 1, 2012 Accepting new patients

Locations

1250 E Tremont St
Hillsboro, IL 62049
Phone (217) 532-6911

1025 S 6th St
Springfield, IL 62703

901 N 1st St
Springfield, IL 62702
Phone (217) 588-2660

775 Engineering Ave
Springfield, IL 62703
Phone (217) 522-4300

2901 Greenbriar Dr
Springfield, IL 62704
Phone (217) 726-5580

Interoperability endpoints

  • Direct secure messaging: joel.wietfeldt.1@28977.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Springfield Clinic Lincoln Rural HealthLincoln, IL, CCN 143925 Rural health clinic Limited Partnership Interest Jan 1, 2015
Springfield Clinic Nokomis Rural HealthNokomis, IL, CCN 783814 Rural health clinic Limited Partnership Interest Jan 1, 2015
Springfield Clinic Raymond Rural HealthRaymond, IL, CCN 783829 Rural health clinic Limited Partnership Interest Jan 1, 2015
Springfield Clinic Neoga Rural HealthNeoga, IL, CCN 783812 Rural health clinic Limited Partnership Interest Jan 1, 2015
Springfield Clinic, LLPMacomb, IL, CCN 783855 Rural health clinic Limited Partnership Interest Jan 1, 2015

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 23

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 23

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589846400000",
    "number": "1497977888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 S 6TH ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627032403",
            "telephone_number": "217-528-7541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 GREENBRIAR DR",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627046425",
            "telephone_number": "217-528-7541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIETFELDT",
        "first_name": "JOEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-03",
        "last_updated": "2020-05-19",
        "certification_date": "2020-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "IL",
            "license": "036129983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "joelwietfeldt@sfc.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "2901 Greenbriar Dr",
            "city": "Springfield",
            "state": "IL",
            "country_code": "US",
            "postal_code": "627046425",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.